Individual
MRS. BRENDA ROSE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3009 SHELLY RD, RAVENNA, OH 44266-9415
(330) 696-3875
Mailing address
3009 SHELLY RD, RAVENNA, OH 44266-9415
(330) 696-3875
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
146330
OH
Other
Enumeration date
01/09/2012
Last updated
01/09/2012
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